The Texas health system is using a diabetes care management program that tracks engagement and pushes targeted resources and interactions to address care gaps and costs.
Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.
United Regional Health Care is seeing good results from a digital health program that ties together prescriptions and supplies, access to education and other resources, and connections to care providers for employees living with diabetes.
Through the program, the Texas-based health system can track per-member costs along with medication adherence and provider-patient interactions, allowing administrators to get ahead of the cost curve on chronic care management. They can spot gaps in care and personalize messages, resources, and incentives tied to lifestyle and care management.
As a result, they're seeing reductions in ED visits and hospitalizations and improvements in short- and long-term clinical outcomes.
"It's been a very positive program for us," says Heather Hormel, senior director of human resources for the health system. "It's a good way for us to remove barriers for people [who live with] diabetes and for those who manage care for people with diabetes."
Healthcare organizations, including health systems and payers, have long sought to improve chronic care management through technology and strategies that focus on more frequent interactions. Many are turning to remote patient monitoring platforms that allow care providers to interact with patients on demand at home, alongside other channels that can handle tasks such as supplies and education.
Heather Hormel, senior director of human resources for United Regional Health Care. Photo courtesy URHC.
United Regional Health Care works with Dallas-based CCS on this program, a partnership that has been in place since 2016. CCS, which began in the home-delivered medical supply business, has more recently expanded into education, monitoring, and clinical support through its LivingConnected program, in which it partners with digital health companies Welldoc and ZeOmega.
"The experience for those living with chronic diseases is fragmented, at best. At worst, it's negatively impacting the health outcomes and actual lives of patients," Marian Lowe, CCS' executive vice president and general manager of digital health, said in a press release. "That's why we're excited to bring together connected device data and marry that to the member's healthcare utilization through this partnership. Only then can we truly do more to help maximize preventive care and minimize unnecessary use of costly emergency department visits and hospitalizations."
To Hormel, the LivingConnected platform gives United Health an opportunity to help manage care for employees who might have difficulty integrating daily health and wellness habits to stay on top of a chronic disease that, if not managed properly, can lead to worsening health and death.
"It's all about engagement," she says. "Doctors are still very much driven by volume, and there are limits to their interactions. Health plans are sometimes able to coordinate those interactions better and can even be more proactive."
Diabetes care might be an ideal test case for this platform. Some 34.2 million Americans are now diagnosed with the disease, and the Centers for Disease Control and Prevention (CDC) estimates roughly one-quarter of all US healthcare costs are tied to diabetes care. Care management, meanwhile, is very much affected by lifestyle choices, including diet and exercise, making it vital that providers work with their patients on care management.
Experts estimate some 90% of people newly diagnosed with diabetes don't get the education they need within the first year to manage their condition properly. That includes learning how and when to test their blood sugar, how and when to administer insulin, how diabetes affects their health (including vision, circulation, and moods), how to spot dangerous health concerns like high or low blood sugars, and even how food choices and exercise affects their health.
"It's very expensive just to get the basics," says Hormel. "And that's before you factor in [lifestyle]. Unless you have diabetes, you probably don’t fully understand what it takes to treat it and manage it correctly."
Programs like LivingConnected also represent a point of confluence for payers and care providers, who can work together to manage a consumer's healthcare needs and costs. There are no delays when a member runs low on testing strips or insulin, or when a visit to a primary care provider or specialist is needed.
An important piece of the puzzle, Hormel says, is coaching.
"That's the key to making all of this work," she says. Members who aren't actively engaged in their care management tend to lose track of what they need to do every day, skipping tests or medication, and falling into bad habits that eventually lead to health issues. A member of the care team can connect through digital health channels and offer encouragement or advice, keeping members engaged in their care.
The concept isn't new or ground-breaking, save for the inclusion of digital health tools that improve home monitoring. These types of programs have been slow to gain traction because of the effort involved to produce patient engagement. But as payers and providers look to manage risk in tandem and get a handle on chronic care costs, they're more willing to fine-tune these programs and invest the time and effort into getting the technology and the frequency of interactions right.
"You have to take a leap of faith on this," says Hormel, who cites the cost of medication and diabetic supplies as a pain point that can be tackled through better care management (and one often overlooked in care management programs). "The more flexibility you can add to the program, the better chance you have of making that connection."
A program like LivingConnected, she says, can look at the data for each member and apply incentives to reach certain participation or wellness goals, funnel personalized education and resources, and even set up a coaching plan that kicks in when a specific member is most likely to need that support. The technology, be it AI software that can sift through a patient's insurance claims or smart devices that can track key physiological signs, activity, or medication use, helps to set parameters for those targeted messages or interactions.
As the healthcare industry continues to struggle with costs, they'll be more willing to adopt programs that combine care and cost management and use technology to improve engagement.
"We're learning a lot [through LivingConnected] about how we can improve engagement," Hormel says. "And we have a lot more to learn. But this is a very good way to learn."
The Cancer Support Community is partnering with Equiva Health on a program to equip rural residents living with cancer with a cellular-enabled tablet that gives them access to resources and care providers.
The Cancer Support Community is launching a telehealth program aimed at improving care management for cancer patients living in underserved parts of the country.
CSC, the largest professionally led non-profit cancer support network, is partnering with New York-based CRM company Equiva Health on the program, with a pilot project scheduled to launch this month in Minnesota. Through Gilda's Club Twin Cities, a CSC network partner, participating residents will get a cellular-enabled tablet allowing them to access resources and connect with caregivers.
“From my own experience growing up in rural Virginia, I know firsthand the challenges that you’re met with when living in a remote rural community,” CSC CEO Debbie Weir said in a press release. “We must overcome rural access barriers by advancing telehealth solutions that can seamlessly connect people to resources, to support, to their communities, and to the oncology community at large.”
The project is the latest in a series of digital and connected health programs aimed at improving care management for those living with cancer beyond the hospital, clinic, and doctor's office. Many use remote patient monitoring tools or telehealth platforms to provide on-demand resources and links to providers, with the idea that remote monitoring can allow providers to identify treatments that don’t work and modify care plans on the fly, improving short- and long-term outcomes.
These services are especially important for patients in rural and other underserved areas who have difficulties accessing care. Research by the Centers for Disease Control and Prevention (CDC) has shown that people living with cancer in rural areas have a higher mortality rate than those living in urban regions.
The program will also take into account a patient's ability to access connectivity for the devices. Those who qualify will be invited to apply for the Federal Communications Commission's (FCC) Affordable Connectivity Program (ACP) through an ISP provider.
The University of Maryland Medical Center's mobile integrated health community paramedicine (MIH-CP) program, which sends specially trained paramedics to the homes of selected patients after hospital discharge, saw increases in first-fill prescription rates and medication adherence, according to a study.
A mobile integrated health community paramedicine (MIH-CP) program launched in Baltimore by the University of Maryland Medical Center helped improve medication adherence for patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), according to a new study.
As reported in a recent issue of Exploratory Research in Social and Clinical Pharmacy, an MIH-CP program, which sends specially trained paramedics to the homes of selected chronic care patients following discharge from a hospital, increased first-fill prescription rates by almost 20% for CHF patients and 25% for COPD patients in the first 30 days. In addition, the program boosted medication adherence by 8% to 14% over 60 days.
The results show promise for an innovative program that's designed to improve chronic care management at home, reduce adverse health events and cut back on 911 calls by so-called "frequent flyers," or patients who often need emergency healthcare services and rack up large healthcare bills.
The Maryland program was coordinated through the health system's Epic electronic health record platform in a partnership with digital health company DrFirst, and focused on pharmacist-led interventions.
“These results are particularly exciting because patients with chronic health conditions are at greater risk of poor outcomes if they don’t take their medications as prescribed,” Colin Banas, MD, MHA, chief medical officer for DrFirst and one of the study’s authors, said in a press release. “Pharmacist-led programs like this have a long history of improving medication use. As value-based care and risk-based contracts grow in prominence, healthcare organizations are turning to innovative ways to manage care for high-risk patients, so they have better health outcomes and stay out of the hospital as much as possible.”
The health system identified high-risk patients with CHF or COPD as they were discharged from the hospital and assigned them to the MIH-CP program for follow-up care. That care includes home visits by a team of community paramedics and a pharmacy technician and a virtual care link to pharmacists, community health workers and a physician or nurse practitioner.
Some 83 patients took part in the six-month study, with 43 assigned to the MIH-CP program and 40 to traditional follow-up care.
The study's authors note that patients with CHF or COPD run a high risk of hospital readmission due to acute exacerbation, leading to high healthcare costs and penalties from the Centers for Medicare & Medicaid Services for preventable rehospitalizations. Part of the problem is that many of these patients don’t follow doctors' orders on medication management.
"Efforts to integrate inpatient and outpatient medication regimens remain critical for the prevention of medication non-adherence during transitions of care and help to identify medication non-adherence at timepoints," the study concluded. "Transition of care programs such as MIH-CP, which incorporate pharmacists as part of the team, support the identification and resolution of critical medication-related problems and medication non-adherence. These types of programs can provide much-needed care and support for a largely underserved community."
Health systems across the country are experimenting with MIH and CP program in various forms and targeting different patient populations. Some create a program through their own EMS services, while others partner with local EMS providers and other community health programs.
Home visits run the gamut as well, with care providers offering chronic care management services, addressing social determinants of health, even just chatting for a while with someone who might be home-bound and lonely.
A new survey from the Merritt Group finds that CIOs value input from key industry and thought leaders, as well as the media, when purchasing technology. And industry events are popular again as well.
Healthcare CIOs considering their next big technology purchase are looking to media and key industry and thought leaders for input on what to buy. And they're not all that interested in Twitter, Facebook, or the latest whitepapers.
That's the takeaway from a survey of 20 CIOs conducted by the Merritt Group, a marketing and PR firm. It speaks to the challenges faced by health system leaders as they sift through the ever-growing vendor landscape to find the right tool or platform.
According to the survey, 90% of CIOs say the endorsements of key opinion leaders and industry influencers add weight to their purchasing strategy, and 70% use the media to influence their decisions. Some 80% get their healthcare news from the media—trade publications, medical journals, professional organizations, and business press—while only 40% look at social media and 20% listen to podcasts.
In a blog accompanying the survey, Shea Lawless, a public relations account executives for the Merritt Group, says the survey results are a sharp turn-around from a previous survey that saw CIOs rank the media as the least favorite source of information.
"This points to the fact that CIOs aren’t looking to the media for [healthcare technology] vendors touting their solutions," she wrote. "Instead, they turn to the media for the seismic trends that will affect their business and patients. Healthcare technology vendors should focus on producing thought leadership content on these trends to educate the media and position themselves as trusted sources."
After media, the outside forces impacting buying decisions drops off. Only half of the CIOs surveyed say pressure from their health system affects what they buy, while 45% are swayed by what their competitors are buying, 35% pay attention to the "buzz around new diseases," and a quarter heed pressure from consumers or patients.
And after a few years of disruption caused by the pandemic, CIOs are interested in the live event circuit again. Three-quarters of those surveyed say they get product and vendor information from events.
"Anecdotally, we have also heard that many events held since COVID-19 are not reaching the same scale and having the same impact they used to," Lawless said in her blog. "Despite that, CIOs still find it to be an important element of their purchasing decisions, so marketers must keep that in mind."
As for vendor-initiated content, 75% of CIOs surveyed say videos work for them, while 65% are partial to case studies and 60% like either vendor websites or webinars. What doesn't click for them are social media (only 40% are interested) and whitepapers (30%).
The senior vice president of care transformation and innovation for the multi-state health system says successful change begins with a focus on processes and workflow.
Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.
For Michael Schlosser, MD, MBA, the key to innovation and transformation lies in workflows. Figure out how care is delivered first, then improve that process through new technology or strategies.
"We focus a lot on workflows because that's where the changes are going to occur," says the senior vice president of care transformation and innovation at HCA Healthcare. "You'll get better outcomes when you focus on the process first."
Schlosser is at the helm of a pretty big ship. Nashville-based HCA Healthcare comprises 186 hospitals and roughly 2,000 sites of care in 21 states and the UK. The organization set its sights on the health system of the future in 2021, when it created the Department of Care Transformation and Innovation (CT&I) and put Schlosser, then its chief medical officer, in charge.
"Looking down the road is what our office should be doing," he says. "Healthcare moves slowly and changes slowly, so we have to [plan carefully] to make that happen."
Michael Schlosser, MD, MBA, senior vice president of care transformation and innovation at HCA Healthcare. Photo courtesy HCA Healthcare.
To Schlosser, innovation has always been part of the healthcare landscape, even if it does take a while for unconventional ideas to be accepted. But transformation is a new concept, fueled in large part by the challenges created by the pandemic. Health systems and hospitals jumped on the digital health and telehealth bandwagon in droves as COVID-19 took over, and while the technology itself worked well, many organizations had trouble making it interoperable. Workflows and processes weren't well thought out, and care teams struggled to adjust.
"We need to focus on operational transformation," he says.
"Wd caught lightning in a bottle," Schlosser adds, looking back over the past few years. "The pandemic had created an environment interested in … change, which was different than the way things generally happen in healthcare. Adjusting wasn't easy."
As the pandemic fades (hopefully) into the rear-view mirror, he says, healthcare organizations have to adjust their strategies to look forward rather than just keeping up. New technologies and ideas that have proven their value need to be stitched into the fabric of the organization, not bolted onto the side like a new room added to a house. And that means pulling all of the different departments together, from IT to nursing to marketing and PR, to ensure that buy-in is complete and workflows are designed that benefit both provider and patient.
That could be a challenge for a health system as big as HCA Healthcare, but Schlosser says the size and breadth of the organization also offer unique opportunities. The health system has designated two Innovation Hub hospitals, UCF Lake Nona Hospital in Orlando and TriStar Hendersonville Medical Center in Hendersonville, Tennessee, which serve as two unique and individual sites for designing and testing innovative concepts.
"They have the bedside experience to serve as labs," says Schlosser.
But that doesn't mean those two hospitals are the only testing grounds. Schlosser says inspiration is "both structured and unstructured." It's discussed in advisory groups, eyed in other sources outside healthcare, and given the chance to grow in CT&I.
"We've become the funnel for innovation all over the organizations," he says.
As an example, HCA Healthcare identified a particular pain point in the managing of staff and scheduling and the assignment of care teams.
Schlosser says CT&I studied how patients were assigned care teams, built data science tools to create a patient-by-patient grid of care needs, then developed AI software to predict traffic and, in essence, "fill in the blanks" where care gaps surfaced. Working with Google, they created an automated scheduling platform that identifies and matches staff and their capabilities with patient care needs and procedures that need certain competencies.
"It's an iterative design format: Input from stakeholders was crucial at every stage of the process, and this process had several stages," he says. "We decided to test this in the labor & delivery space first because it's bit like a hospital within a hospital, with a lot of opportunities for improvement."
Schlosser says the platform is now in use in three hospitals and has shown improvements in staff satisfaction and time savings. As they measure how the platform optimizes each hospital's staffing and improves patient care, he says, they'll look to expand to L&D units in other hospitals and, eventually, other departments.
Beyond automated scheduling, Schlosser says he wants to tackle documentation, a key pain point and contributing cause to ongoing national epidemic of staff stress and burnout. This will be done not only through automation, but with technology that can capture patient-provider interactions and insert that data into the medical record. A pilot project at UCF Lake Nona Hospital is using smartglasses to record those interactions, allowing providers more quickly and conveniently review and edit their notes in between patient visits.
Schlosser says it's vital now to map out care transformation and innovation over the next five to 10 years, in particular because of the fluid nature of healthcare innovation. With the end of the COVID-19 public health emergency most likely taking place in 2023, it will be important to keep track of expiring waivers and incentives designed to improve telehealth and digital health adoption, and to adjust plans accordingly to continue supporting those programs.
"We're not focused just on technology, but a strategic understanding of how to redesign and enhance care delivery, and all that goes into it," he says. "Now we have a dedicated, focused, multidisciplinary team who wakes up every day thinking about this."
The survey of 1,000 commercially insured consumers finds that they used telehealth because it's more convenient than a trip to the doctor's office, but frequency is still an issue.
Convenience is still the top reason that consumers enrolled in commercial insurance plans use telehealth, and most would like Congress to make sure it stays that way.
Almost 70 percent of respondents to a survey commissioned by America's Health Insurance Plans (AHIP) in October said they've used telehealth during the past year because it's more convenient that a trip to the doctor's office, clinic, or hospital. And almost 80% say telehealth makes it easier for them to access care when they need it.
“Patients and providers accept – and often prefer – digital technologies as an essential part of health care delivery,” Jeanette Thornton, AHIP's executive vice president of policy and strategy, said in a press release announcing the survey of 1,000 consumers, which was conducted by NORC and the University of Chicago. “Telehealth can be just as effective as in-person care for many conditions and allows patients to receive more services ‘where they are.’ That’s why health insurance providers are committed to strengthening and improving both access and use for the millions of Americans who use telehealth for their healthcare needs.”
The news isn't earth-shattering, as many surveys have highlighted consumer preference for telehealth, particularly in the wake of the pandemic. But it does add to the library of evidence that consumers will seek out a healthcare provider or health plan that features telehealth, and it reinforces the need for hybrid care strategies that allow for a choice between virtual and in-person care when available and appropriate.
That's especially true of women, who were almost four times more likely than men to say they used telehealth because they lacked childcare or eldercare services.
Overall, 46 percent of those surveyed said they used telehealth because they weren't able to schedule an in-person appointment, while 24% said they wanted to save money and 23% used telehealth because their doctor's office was closed (a nod to the value of telehealth for after-hours and weekend care).
Among other data points, 85% of those surveyed said there are an adequate number of care providers available to them via telehealth for the needs they have, an indication that virtual care is helping to alleviate the provider shortage and improving access.
And telehealth use among the low-to-middle income brackets is about the same or slightly higher than use in the higher income ($100,000+) bracket. That might mean telehealth is helping to address gaps in care experienced by lower income consumers, or it may conversely highlight the fact that lower-income consumers aren't able or willing to take advantage of telehealth.
The latter would seem more likely. According to the survey, 36% of respondents used telehealth just once over the past year, while 53% used it between two and five times, 4% used it between five and 10 times and 5% used it more than 10 times. This means telehealth adoption is still on the low end, even after the pandemic.
Telehealth use had surged during the pandemic, as healthcare organizations sought to push as many services as possible onto virtual care platforms to reduce traffic at hospitals and insulate both patients and providers from COVID-19. Providers were helped in this fashion by state and federal legislation, as well as waivers from the Centers for Medicare & Medicaid Services (CMS) aimed at boosting access to and reimbursement for telehealth during the public health emergency (PHE). Many of those orders and waivers will expire when the PHE ends sometime next year, which could greatly affect telehealth use as health systems cut back their services.
Telehealth advocates are pressing Congress to make those waivers permanent, and consumers are behind that effort. According to the survey, 73% said Congress should act to make sure those waivers stay in place.
The Pentagon is planning to hire 2,000 healthcare professionals to address a wide range of health concerns, from suicide and dangerous behaviors to social determinants of health.
The Pentagon is getting serious about workplace wellness, with plans to create a "first of its kind" mental health program.
Deputy Secretary of Defense Kathleen Hicks said the Department of Defense is looking to create a department of some 2,000 healthcare staff to handle a wide range of issues, from suicide to social determinants of health.
“That could be on financial stability; it could be on food security; it could be on relationship issues," she said during a recent Washington Post online event. "All the factors that go into causing stress and harm behaviors, including suicide.”
"We are quite confident that's a very science-based approach that we're using," she added. "It's the largest effort like ... this that has ever existed at an unprecedented scale …. This prevention workforce will be a first-of-its-kind, and we're going to do it right here in the United States military because that's what we owe our people and their families."
While a report issued in October by the DoD indicated suicides in the military have dropped 15% from 2020 to 2021, the military isn't immune to the mental health crisis affecting the country, seen in rising rates of substance abuse, family stress and other harmful behaviors. Programs like REACH (Resources Exist, Asking Can Help) and CALM (Counseling Access to Lethal Means education) aim to help service members and healthcare professionals address these issues, but the DoD now wants to establish a dedicated workforce.
Some resources feature digital health and telehealth technology, designed to give service members and their families on-demand access to resources, include healthcare professionals, through mHealth apps and virtual visits. Those access points are designed to tackle the stigma of "being seen" as needing help.
"We have a number of initiatives underway now to make sure we remove that stigma, not just that it's not ... bad to seek help, if you will, for your behaviors, for your mental health, but really that it's a sign of strength," Hicks said.
That includes addressing thoughts of suicide and lethal force.
"We know, and it's well documented, that if we can create a little time and space between that ideation, that idea of having concerns about ... potentially committing suicide and those lethal means — obviously, firearms being foremost, but also medications — if we can create that time and space, create some safety, then that reduces the likelihood of suicide," she added.
A new survey from the Center for Connected Medicine and KLAS Research finds that patient access is still top of mind for most health system leaders, with telehealth, AI and scheduling tools the most popular tools in the toolkit.
Health system leaders are focused on using digital health technology during the coming year to improve patient access, according to a new survey from the Center for Connected Medicine (CCM) and KLAS Research. And they're most interested in using telehealth and AI to improve engagement and help patients find what they need.
While "patient access" is a broad term, it highlights the emphasis being placed by health systems on patient-centered care, and creating new and better connections between patients and their care teams, particularly at a time when the competition is fierce for healthcare services.
The Top of Mind for Top Health Systems 2023 report, released this week by CCM, the innovation arm of UPMC, and KLAS Research, represents the thoughts of 61 leaders from 59 healthcare organizations, and marks the second year in a row that patient access is at the top of the to-do list. Some 28% of those surveyed for this year's report rated it as the problem that has the greatest potential to be improved via digital health--and one that has been greatly impacted by the pandemic.
“It’s no secret that health systems have been facing significant challenges since the start of the COVID-19 pandemic and must address consumer demands for greater convenience and accessibility from their healthcare providers," Joon Lee, MD, executive vice president of UPMC and president of UPMC Physician Services, said in a press release. "This report reflects the priority that we and others are placing on patient access, including more options for virtual care, greater self-scheduling functionality, and higher engagement with patient portals.”
The biggest challenge to improving patient access, meanwhile, isn't technology, but the people behind the technology. That might be the patient who's not overly concerned about healthcare or healthcare providers and staff who aren't too thrilled with changing the status quo.
"Respondents specifically cited the difficulty of getting patients to be engaged in their own healthcare," the survey reported. "Many also talked about organizational change management--in other words, guiding the people in healthcare organizations to buy into and make changes. This is particularly important for implementing patient access tools."
With that in mind, according to the survey, the highest priority for improving patient access is process change.
"One CEO explained why this focus on process is so vital: 'The process varies from practice to practice and hospital to hospital,'" the survey noted. "'Trying to standardize these processes is maddening. Our organization used to be one hospital, but now we have more than 15 hospitals. We have just not been able to get all those people on the same processes so we can actually realize efficiencies of scale.' Healthcare organizations are often turning to vendors to help guide effective processes around new or existing technology."
As for what technologies are considered important to improving patient access, telehealth tops the list, with 56% of survey respondents placing high value on virtual care. Close behind are the patient portal (55%), patient appointment reminders (55%), online bill paying (52%), online registration (49%), an online provider directory (47%), and patient scheduling reminders (46%).
Those top technologies also have their drawbacks. Patient portals are considered the baseline technology for interacting with patients, but patient adoption has been low. Patient self-scheduling technology is considered vital to meeting the needs of today's consumers, yet health systems are reporting problems with achieving provider buy-in and finding the right technology that can handle such a complex task. And while telehealth technology is considered effective and improving patient access, there are problems ensuring that access, ranging from broadband issues to a lack of resources for underserved communities.
The survey also found that:
65% of health system executives see price transparency and cost estimation as important facets of patient access, but almost all say they’re compelled to do so by federal regulations, rather than a desire to improve the patient experience. And most of those surveyed say the biggest challenge to delivering price transparency is the complexity of determining a patient's bill.
A little more than half of health executives are using AI for patient access, and close to 70& believe it will be important in the future in improving access.
Telehealth use has decreased since the pandemic, with most organizations reporting using it for less than 20% of appointments. Patient convenience is the most cited benefit of telehealth, and many want to use it more often, but the uncertain reimbursement landscape is the biggest obstacle to growth.
Most health system leaders surveyed say telehealth is adequately addressing physician workflow and care delivery needs, though roughly one-third say the technology isn't effective, mainly because it doesn't integrate with the EHR or there are too many solutions on the market. Most of those surveyed do feel that telehealth is adequately expressing patient experience needs.
A survey of CHIME executives by digital health company symplr, unveiled during the HLTH conference, indicates executives have adopted new technology at a fast pace, but those new tools and software solutions aren't always compatible.
Health system leaders say they're being swamped by technology solutions that don't integrate with other solutions, and it's costing them a lot of money and stress.
This, in turn, puts more pressure on the enterprise, increasing clinician burnout, complicating patient care, and slowing the pace of healthcare innovation.
Those takeaways can be found in a survey of 132 members of the College of Healthcare Information Management Executives (CHIME), conducted by Michigan-based digital health company symplr and unveiled during the recent HLTH conference in Las Vegas. It paints a picture of an industry that has been embracing new technology at a rapid pace, but hasn't been making sure those new tools and software solutions play well together.
According to the 2022 symplr Compass Survey, about 60% of respondents are using between 50 and 500 point solutions to manage healthcare operations, including roughly a quarter who are using at least 151 point solutions. Meanwhile, 88% say that working with all these IT systems and applications complicates their job.
And that's causing a lot of problems, including lost revenues, workforce stress and burnout and an inability to truly take advantage of innovative technologies to advance clinical care and improve workloads.
The problem has been compounded by the pandemic, which saw healthcare organizations adopt new technologies—particularly digital health and telehealth—at a dizzying pace. Many of these new point solutions were not integrated, leading to siloed platforms and, according to the symplr report "resulting in a decrease in management's confidence in the integrity of their operational infrastructure."
According to the survey, technology integration and interoperability could address a number of pain points for a health system. Almost 41% of those surveyed cited financial pressure as their biggest concern, while another 31% cited staffing challenges and clinician burnout and 22% listed patient privacy and cybersecurity.
Aside from finding cost savings in reduced IT expenses through better integration, executives say a more fluid and integrated technology platform would reduce stress on clinicians, including nurses, who often have to jump from one station or solution to another. Almost a quarter of executives surveyed say enabling their clinician workforce is their top priority when it comes to managing operations, and 84% say a streamlined IT infrastructure is an extremely or moderately important factor in their ability to keep clinicians.
“There’s a lot of concern about the danger of alarm and alert fatigue for nurses, and health systems are under increasing pressure to streamline and simplify clinical communications and processes,” Donna Summers, MSN, RN-BC, the Henry Ford Health System's chief nursing informatics officer, said in the report.
“Clinical collaboration among multidisciplinary teams is essential to improving care quality and creating efficient care delivery with very tight resources, and it is achievable by using the right technologies,” added Michele Strickland, MBA, BSN, RN, Asante's director of informatics and applications.
The symplr survey cited the 2022 Bain & Company KLAS Research report on the state of healthcare IT spending, which noted that healthcare organizations are rethinking their IT strategies and looking to streamline their IT stacks. According to that report, about a quarter of providers say their existing IT infrastructures are keeping them too busy to stay current on new offerings in the market, while a lack of cross-solution interoperability and poor EHR integration are hindering growth.
"Almost 80% of providers say labor shortages, inflation concerns, or specific organizational situations (like M&A or leadership changes) are top catalysts sparking new investments, and 95% of provider organizations expect to make new software investments in the next year despite economic uncertainty," the Bain/KLAS report noted.
All of this boils down to a four-pronged strategy for improving IT operations. According to the symplr report, healthcare organizations should use technology that unifies siloed systems and streamlines administrative tasks, offering efficiencies in:
Financial health, through enterprise tools that identify cost-containment strategies and value and savings opportunities;
Clinical communications, with automated provider processes and improved collaboration tools that enable staff to focus on patient care;
Technology consolidation, through standardized, scalable enterprise solutions that enable health systems to avoid data risks and regulatory penalties while curbing costs; and
Patient-centric care, with new digital health and telehealth platforms that cater to patient preferences and improve the patient-provider dynamic.
“To reduce costs without compromising service, we analyzed spending at the cost center level, discovering that we were inefficient across the system and uncovering huge savings opportunities," Kevin Smith, Luminis Health's chief financial officer, said in the report. "By adopting new operating measures, the health system has saved millions of dollars.”
A newly launched venture collaborative in Chicago aims to bring together health systems, corporate partners, innovative startups, and community resources to tackle health inequity.
A lot of the conversation in healthcare innovation these days centers around new partnerships to address health equity. In Chicago, a unique venture collaborative is forging those partnerships between health systems and community organizations, while closing gaps in care that contribute to wasteful healthcare spending.
Chicago ARC (Accelerate, Redesign, Collaborate) was launched in June 2022 on a model designed by Israel's Sheba Medical Center, a global leader in transforming healthcare delivery through innovation. Chicago ARC's goal is to create programs that bring together health systems and the communities they serve and take on barriers to accessing healthcare.
"These challenges have always been going on," says Kate Merton, PhD, Chicago ARC's executive director. "There's no one I know who doesn't want to solve that. It's getting down to the devil in the details … that takes time and effort."
Chicago ARC's healthcare partners are the University of Chicago Medical Center (UChicago Medicine) and the Sinai Chicago health system. The two health systems signed memorandums of understanding in June with the new organization, agreeing to support innovation that addresses such issues as maternal and child health, chronic disease management, rural and urban healthcare disparities, senior services, home-based healthcare, and behavioral health.
Kate Merton, PhD, executive director of Chicago ARC. Photo courtesy Chicago ARC.
"The south side of Chicago has experienced shrinking healthcare resources for many years," Kenneth Polonsky, MD, UChicago Medicine's executive vice president for medical affairs and dean of the biological sciences division, said in a press release announcing the collaboration. "Partnering with the Chicago ARC creates the dual benefit of identifying and integrating global technologies that meet the needs of our patients and healthcare professionals while enabling the University of Chicago to bring its research and innovation expertise to a local and global community seeking to address health inequities."
Armed with a $100 million investment fund, Chicago ARC will connect those health systems with local community organizations, venture capital funding, corporate partners, and startups to design programs that might include affordable housing, food resources, childcare, social services, transportation, and schools.
"Our job is to understand what keeps [healthcare executives] awake at night," says Merton, referencing the surge of attention being paid to social determinants of health and barriers to care that keep people and communities from accessing the care they need.
Much of that attention was brought on by the pandemic, which highlighted the plight of underserved populations and communities and turned the spotlight on digital health and telehealth as a means of addressing those inequities.
"COVID has incentivized innovation," Merton says. "People are more willing to take that leap now and try new things."
Chicago ARC may be an ideal example of healthcare innovation strategies discussed at the recent HLTH 2022 conference in Las Vegas, which included companies, startups, and ideas not usually associated with healthcare delivery. The conference helped to spotlight the benefits and challenges of partnerships, and the growing idea that innovation needs to expand its sights and adopt some unconventional concepts to tackle the biggest pain points in healthcare today.
These ideas also point out that healthcare—especially primary care—is getting crowded. New players like Amazon and Google are entering the market, alongside telehealth companies, payers, and retail giants like Walgreens, CVS and Walmart. All are offering unique access points to healthcare and their own banks of providers that compete with the local health system, clinic, or private practice.
Merton says collaborations like Chicago ARC give health systems an opportunity to get in front of those competitors.
"Industries outside healthcare will certainly have an impact on healthcare," she says. "But it's very easy to get distracted by the shiny ball."
The key to innovation, she says, is financial sustainability. A new program may look good and address a pain point in care access or delivery, but it won’t go anywhere if it can't support itself and find the right path to continued use. That's where payers, corporate partners, and even financial institutions play a role. They can highlight the processes needed to maintain sustainability.
Merton notes that payers are influencing healthcare innovation and have some pretty good ideas themselves—especially in health plans that support health and wellness—but they have their own business models.
A more important partner, she says, might be the Centers for Medicare & Medicaid Services (CMS), which covers a significant percentage of the population that would benefit from the programs and partnerships that Chicago ARC would be developing. CMS is conservative in embracing innovation, often calling for a good deal of research and data to support new technologies like telehealth and digital health for considering reimbursement, but the CMS Center for Medicare & Medicaid Innovation has been showing interest in new programs that address health inequity.
Merton says the goal now is to develop "a shopping list" of innovative ideas, then match the resources with programs aimed at addressing those ideas. With more people and organizations at the table, more opportunities will result.
"Imaginative thinking can truly make a difference when it's executed properly," she says.
